颈动脉支架置入术后的微栓塞对患者短期认知损害的影响

The Effect of Microembolization after Carotid Artery Stenting on Short-term Cognitive Function Changes

目的了解颈动脉支架植入术(CAS)后微栓塞发生率以及微栓塞对患者短期认知功能的影响。方法前瞻性收集2017年10月至2018年11月在南通大学附属医院神经内科接受颈动脉支架成形术治疗的32例患者的临床资料,分别在术前<7 d和术后第1天行头颅3.0T MRI检查,于术后MRI弥散加权成像(DWI)图像上确定手术相关的微栓塞。根据术后是否出现微栓塞分为微栓塞组(22例)和无微栓塞组(10例)。术前<3 d和术后1个月采用简易精神状态量表(MMSE)和中文版蒙特利尔认知评估量表(MoCA)对入组病例进行认知功能评估,比较两组的认知功能;分析不同部位微栓塞以及微栓塞体积对患者认知损害的影响。结果微栓塞组手术相关微栓塞发生率为69%(22例),术后1个月MMSE量表和MoCA量表评分差值较术前下降,差异有统计学意义(P<0.000)。术后微栓塞体积与认知功能评分呈负相关关系;不同部位微栓塞对患者术后1个月MMSE量表、MoCA量表评分有影响。线性回归分析显示,微栓塞组与无微栓塞组患者比较,微栓塞组患者术后1个月可出现认知损害表现。结论 CAS后患者的微栓塞发生率较高,微栓塞可导致患者术后近期认知损害,微栓塞体积与认知功能评分呈负相关;微栓塞不同发生部位是认知损害的影响因素。

Aim To understand the incidence of microembolization after carotid artery stenting(CAS) and the effect of microembolization on short-term neurocognitive function. Methods The clinical data of 32 patients who underwent carotid stenting in the hospital from October 2017 to November 2018 were collected prospectively, and 3.0 Tesla magnetic resonance imaging(MRI) scanner was performed. Diffusion-weighted magnetic resonance imaging sequencing was performed within 7 days preoperatively and less than 24 hours postoperatively. Microembolization were identified by regions of hyperintensity on diffusion weighted imaging(DWI). Cognitive function was evaluated in all enrolled cases within 3 days before surgery, One month after surgery, Mini-mental State Examination(MMSE) and the Chinese version of the Montreal Cognitive Assessment Scale(MoCA) were used to test cognitive function, and according to whether there were microembolization after the treatment, patients were divided into a microembolization group and a no-microembolization group. The effects of cognitive function on the two groups were compared. The effects of different locations of the microembolization and the volume of the microembolization on cognition were analyzed. Results The study included 32 patients who underwent CAS, the incidence of procedure-related embolization was 69%. The MMSE and MoCA scores showed decline 1 month postoperatively in microembolization group, and the difference was statistically significant. The volume of procedure-related embolization was a significant negative correlation with cognitive function. Linear regression analysis showed that patients with microembolization had a decline in cognitive function 1 month after surgery compared with the patients without post-CAS. Conclusion The incidence of microembolization in patients of post-CAS is high. Microembolization can lead to a decline in cognitive function at 1 month after the intervention. The volume of microembolization was negatively correlated with cognitive function scores. Microembolization at different sites has an effect on cognitive changes.